Meaningful youth engagement in sexual and reproductive health and rights decision making
Authors: Klaudia Szymuś, Natnicha Manaboriboon, Fatima Elbasri Abuelgasim Mohammed, Kaché Faith Hanna, Ebuka Heritage Okonkwo, Maria Măties, Michel Nasrallah, Vedant Shukla
Journal: The Lancet Global Health (2023)

The UN defines youth as individuals aged 15–24 years. They make up 16% of the global population, or 1·2 billion people—one of the largest demographics globally.1United NationsTen key messages.https://www.un.org/development/desa/youth/wp-content/uploads/sites/21/2019/08/WYP2019_10-Key-Messages_GZ_8AUG19.pdfDate: Aug 12, 2019Date accessed: November 6, 2022Google Scholar They deserve meaningful engagement in decisions affecting them, which entails their involvement at all stages of decision making: in research, design, implementation, monitoring, and evaluation of interventions.2International Federation of Medical Students' AssociationsIFMSA policy document: meaningful youth engagement.https://ifmsa.org/wp-content/uploads/2023/10/IFMSA-Policy-Document-on-Meaningful-Youth-Engagement-.docx.pdfDate: Aug 1, 2023Date accessed: October 11, 2023Google Scholar Meaningful engagement in decision making comes from international treaties such as the Universal Declaration of Human Rights and the UN Convention on the Rights of the Child.3United Nations Economic and Social CouncilAchieving gender equality and the empowerment of all women and girls in the context of climate change, environmental and disaster risk reduction policies and programmes.https://www.unwomen.org/sites/default/files/2022-03/CSW66%20Agreed%20Conclusions_Advance%20unedited%20version_25%20March%202022.pdfDate: March 25, 2022Date accessed: October 11, 2023Google Scholar WHO recognises the vital role of young people in addressing various health challenges through the establishment of the WHO Youth Council. In some countries, inadequate policies on universal health coverage and medical insurance create barriers to accessing sexual reproductive health services for young people. The higher unemployment rate and increased risk of poverty in young people compared with the general population further hinder their access to sexual and reproductive health and rights (SRHR) services due to insurance ineligibility and affordability. SRHR services include access to contraception, abortion, in vitro fertilisation, menstrual counselling and management, treatment and prevention of sexually transmitted infections, and domestic violence prevention. Barriers to accessing SRHR services have been shown to reduce use of these services by young people. Beyond the barriers related to sexual health among all age groups, young people face additional problems, including a scarcity of services tailored to their unique needs (eg, needing parental consent for the services or having less financial independence to cover services' expenses and to travel) and impaired access to post-service follow-up. This can be due to concerns around privacy (eg, how to send a message regarding a follow-up visit that does not expose the person), and an absence of discussion around how to minimise barriers for their next visit.4Braeken D Rondinelli I Sexual and reproductive health needs of young people: matching needs with systems.Int J Gynaecol Obstet. 2012; 119: 60-63Crossref PubMed Scopus (0) Google Scholar, 5Peterson A Drake P Tat S Silver G Bell H Guinosso S Youth engagement in sexual health programs and services: findings from the Youth Engagement Network's environmental scan.https://pages.etr.org/hubfs/YEN/ETR_YEN%20Environmental%20Scan%20Full%20Report_2020.pdfDate: December, 2020Date accessed: October 11, 2023Google Scholar Many young people live in low-income and middle-income countries where access to primary health services is often poorer than that of high-income countries. This inability to access health services is concerning because young people are disproportionately affected by SRHR disparities.6UNWorld population prospects 2019: highlights.https://population.un.org/wpp/Publications/Files/wpp2019_10KeyFindings.pdfDate: June, 2019Date accessed: November 4, 2023Google Scholar If these challenges persist, they will magnify as the number of young people increases globally, posing substantial public health consequences. Although young people share common challenges, they are a diverse group. Implementing uniform SRHR services without considering this diversity overlooks equity and multisectoral approaches. Despite available tools for meaningful engagement, barriers persist in policy making and implementation. Young people are often not considered relevant: they represent 1·65% of youth lawmakers worldwide, despite representing 10% of the world's population.7UN YouthDefinition of youth.https://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-political-participation.pdfDate: Jan 23, 2013Date accessed: November 7, 2022Google Scholar Even when they are involved in governance, they can be subject to tokenism, a process of superficial inclusion and influence. Moreover, insufficient funding for youth programmes, a scarcity of mentors or guidance, and obligating young people to take unpaid roles in political processes hinders the participation of young people. These factors limit learning, are inaccessible without independent wealth, and create costs for participation, favouring engagement of those who can afford or dedicate their free time to unpaid work and already have leadership experience.2International Federation of Medical Students' AssociationsIFMSA policy document: meaningful youth engagement.https://ifmsa.org/wp-content/uploads/2023/10/IFMSA-Policy-Document-on-Meaningful-Youth-Engagement-.docx.pdfDate: Aug 1, 2023Date accessed: October 11, 2023Google Scholar Young people are key beneficiaries and catalysts for change in comprehensive SRHR programmes. However, their exclusion from decision making has resulted in programmes not being tailored to the needs and challenges of young people, despite their pivotal role in destigmatising SRHR topics and increasing awareness.8Ahumada C Dekkers K Mesman A Saleh L van Vliet J Youth-led organizations and SRHR.https://issuu.com/youthcoalition/docs/youthguide_finalDate: June 21, 2011Date accessed: October 11, 2023Google Scholar Therefore, we offer recommendations to acknowledge and amplify the voices of young people in society. We call for policy makers to incorporate youth perspectives to include their unique insights stemming from their first-hand experiences; these actions will lead to more effective solutions to adequately address the needs of young people. These perspectives should include those of people across diverse social groups, including marginalised populations, by bridging the gap between communities and policy makers. Meaningful engagement should reflect the role of young people in their communities and go beyond consultations. A review of 37 policies found that youth-led efforts are more effective at influencing policies and their implementation at the local level.9Shephard DD How young people influence policy: a literature review policy brief.https://www.oxfamnovib.nl/Redactie/Downloads/English/publications/v1%20308_Oxfam%20Policy%20Brief_Youth%20Influencing%20Policies%20in%20the%2021st%20Century.pdfDate: March, 2017Date accessed: October 11, 2023Google Scholar Lastly, involving youth in decision making nurtures future leaders, ensuring sustainable SRHR outcomes. We urge national decision makers and international agencies to build youth leadership through learning opportunities. Global Model WHO aims to equip youth with the skills and knowledge to meaningfully engage in global health issues through the WHO Youth Council. The International Federation of Medical Students' Associations created a multitude of sessions and workshops to educate and inform young people on SRHR, enhance health governance skills, and raise awareness about youth health issues.10Program annual impact report. International Federation of Medical Students' Associations, Copenhagen2023Google Scholar Governments should identify and address SRHR challenges faced by young people, which can empower young people to map and voice their concerns, for example through investing in education systems that teach and promote skills such as critical thinking. We urge non-governmental organisations and international agencies to assist governments to secure youth-oriented actions and to involve young people in their own decision making structures. We encourage increasing support through funding, recognition, and technical assistance in individual young people and youth-led organisations and networks. In international settings, we should incorporate youth delegations into decision making events, as seen in WHO's Youth Delegate Program. Collective actions are essential to create a world where youth opinions are valued and to implement a more comprehensive SRHR health-care system. We declare no competing interests.